title: Measuring upper airway volume: accuracy and reliability of Dolphin 3D software compared to manual segmentation in craniosynostosis patients.
abstract: OBJECTIVE
  To test the accuracy and reliability of Dolphin 3-dimensional (3D) software airway analysis compared with manual segmentation in patients who underwent a Le Fort III osteotomy.
  
  
  METHODS
  Computed tomographic scans of 20 patients with syndromic craniosynostosis at Sophia's Children's Hospital (Rotterdam, The Netherlands) were used for airway volume measurements using Dolphin 3D. The same scans had been used for measurement using a manual segmentation method. The results of this previous study were reported in 2010. The manual segmentation measuring result was used as a gold standard. The airway was subdivided into the oropharynx and the nasal passage. A linear mixed effects statistical model was applied.
  
  
  RESULTS
  Dolphin 3D measurements differed from manual segmentation by 9 to 43%, depending on the observer, the time at which the measured scan was acquired (pre- or postoperative), and the airway compartment being measured. The highest accuracy for Dolphin 3D was found for measurements from postoperative scans of the nasal passage.
  
  
  CONCLUSIONS
  The airway analysis tool of Dolphin 3D is not accurate or reliable enough to use in a Le Fort III osteotomy evaluation. When scanning properties are conditioned and measurements are standardized, accuracy and reliability may increase.
authors.affiliation: Undergraduate Medical Student, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands. Electronic address: v.dewater@erasmusmc.nl.
authors.forename: Valerie R
authors.initials: VR
authors.lastname: de Water
authors.affiliation: Maxillofacial Prosthetist, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Joan K
authors.initials: JK
authors.lastname: Saridin
authors.affiliation: Resident, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Frederik
authors.initials: F
authors.lastname: Bouw
authors.affiliation: PhD Student, Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Magdalena M
authors.initials: MM
authors.lastname: Murawska
authors.affiliation: Maxillofacial Surgeon, Department of Oral and Maxillofacial Surgery, Erasmus University Medical Center Rotterdam, Sophia's Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Koudstaal
mesh_terms: D002508:Cephalometry / Q000379:methods / Q000706:statistics & numerical data*; D003398:Craniosynostoses / Q000473:pathology / Q000601:surgery*; D006801:Humans; D006928:Hyoid Bone / Q000473:pathology; D007091:Image Processing, Computer-Assisted / Q000706:statistics & numerical data; D021621:Imaging, Three-Dimensional / Q000706:statistics & numerical data*; D008437:Maxilla / Q000601:surgery; D009296:Nasal Cavity / Q000473:pathology*; D015588:Observer Variation; D009929:Organ Size; D009960:Oropharynx / Q000473:pathology; D019340:Osteotomy, Le Fort / Q000379:methods; D010614:Pharynx / Q000473:pathology*; D015203:Reproducibility of Results; D012984:Software / Q000706:statistics & numerical data*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014609:Uvula / Q000473:pathology